Days 24 & 25: PrisonCare

Only someone living under a rock, or the CEO of an Insurance Company, does not realize that health care in the USA is a serious mess. You can not turn around without coming across an article showing just how bad things are, like how it isn't just the uninsured struggling, but the growing numbers of under-insured.

So it is interesting that in prison we get some basic health care. It is outsourced and care is not completely free to the prisoners, but the rates are pretty reasonable. Each visit to the infirmary costs a small amount, about $3.00. This gets you a nurse who examines you and then decides if you need to see a doctor. If you do - then there are no additional charges. If the nurse decides you do not need a doctor, you can still insist on speaking to one - but for an additional $5.00. The theory is that by putting at least a marginal cost to this "free" service, prisoners will be discouraged from abusing it. That seems to be a reasonable fear, because the infirmary is comparatively clean, air-conditioned, and staffed with females.

I did some digging to see if I could find a copy of the prison's contract with the provider, but I could not. I did find some news reports of the contract though, which indicate that it is costing the County about $2000 per prisoner per year for full health care.

So, despite the claims of the far-right, it is possible to provide some basic affordable health care for all, even in a prison. The prison is a mini-socialist medical scheme, if you ignore the profit motive of the provider. The staff are all hired by the provider (government), and they deliver as much service as they can for a trivial fee ($3 and $5 visits). A market does not exist to set prices, so insisting to see a doctor to remove your appendix costs the same as insisting to see one for a mild cold.

The USA certainly would not be ready for such a scheme, much like the UK's, where most doctors work for the government. The natural first step, of course, would be mandated private insurance combined with price controls (like in Japan or Germany). But the USA needs to do more, first as a moral issue to take care of our less fortunate, but also to remain competitive (health care costs are one of the largest differences between the cost of producing a car in the USA vs. in Japan). The US Government as single-payer for health care costs is the right answer in the long-term, with optional private care available if one would like it (much like Canada).

So the PrisonCare model wouldn't be too bad, except they get a few things drastically wrong. First, I am sure HIPAA applies, so it would be nice if the nurses didn't wander around leaving an inmate's records open on the computer with other prisoners sitting nearby.

But most importantly prison needs to spend time and money on preventative care. If this means the moralizing county residents who insist that prisoners suffer while they are there, are overruled by a State or Federal authority, so be it. Climate control will go a long way to reducing the growth of bacteria, as well as reduce the number of prisoners being taken away due to heat exhaustion (our day room was near 100 degrees the other day). Public spaces, especially bathrooms, should be regularly inspected for cleanliness and receive regular maintenance. For example, one of the urinals in the Work Release area randomly overflows, spilling urine and water all over the floor of the bathroom, where many inmates are only wearing sandals on their feet. Some windows in cells do not open, reducing the amount of fresh air circulating through the prison.

The prisoners should be given an opportunity to get some basic exercise. Since free-weights are unacceptable, some cardiovascular exercise options would be perfect. What is served as food should follow USDA guidelines and the food pyramid, with whole grains, fresh fruits and vegetables supplying the bulk of the calories instead of instant cakes and ground mystery meats and greasy sauces.

CA-MRSA is the biggest concern of the entire prison - the medical provider, the inmates, the COs, and the administration - but it does not seem like common sense is being applied. It certainly is not surprising that a largely sedentary prison population, living on a low-nutrition, high fat/sugar/cholesterol diet, confined to a small area where surfaces are dirtied by human waste, where humidity and temperatures both approach 100, contracts serious infections.

The only gap to be filled which would make it the perfect disease breeding ground is that we aren't sharing our quarters with both swine and fowl...

...yet.